小儿下呼吸道感染的病原菌及耐药性调查

目的调查温州地区小儿下呼吸道感染的病原菌及其耐药性。方法标本经分离培养,做菌株鉴定和药敏试验。结果1763份下呼吸道感染患儿的痰液培养共分离出病原菌715株,总阳性率为40.6%。其中革兰阴性菌448株,占62.7%;革兰阳性菌148株,占20.7%;真菌119株,占16.6%。革兰阴性菌以肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌和鲍曼不动杆菌为主。肺炎克雷伯菌和大肠埃希菌产超广谱β-内酰胺酶(ESBLs)的百分率分别为49.3%和46.5%,较敏感的抗生素为亚胺培南、丁胺卡那霉素、环丙沙星、哌拉西林/他唑巴坦和头孢哌酮/舒巴坦;除铜绿假单胞菌对复方新诺明的耐药率为100%外,铜绿假单胞菌和鲍曼不动杆菌对各种抗生素的耐药性均较低。革兰阳性菌中以肺炎链球菌和金黄色葡萄球菌为主。肺炎链球菌对青霉素的耐药率达到71.1%,对环丙沙星和万古霉素敏感,耐药率为0%。金黄色葡萄球菌中MRSA占18.0%,对环丙沙星、左旋氧氟沙星和万古霉素敏感。结论小儿下呼吸道感染的病原菌以革兰阴性菌为主,肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌、肺炎链球菌、金黄色葡萄球菌为主要病原菌。对抗生素的耐药性较强,临床上应注意对这些菌株的检测,积极防治。

Objective To investigate the pathogen and antibiotic resistance in the lower respiratory infection of children. Methods Bacteria were isolated and identified, antibiotic resistance was detected , Results In 1763 cases,715 strains were obtained from lower respiratory tract sputum samples of children , among them , 448 were garm - negative bacterian（40.6% ） ; 148 strains were gram positive bacteria（20.7% ） ; 119 strains were（ 16.6% ）, K. pneumoniae , E. coli, Ps, aeruginosa and A. baumanii were gram - negative bacterium＇ s primary pathogen. The ratio of FSBLs K. pneumoniae and E. coli was 49.3% and 46.5%, respectively, the sensitive antibiotics for them were imipenem, amikacin, ciprofloxacin, piperacillin- tazobactam, and cefoperazone- sulbactam. Antibiotics resistance of Ps. aeraginosa and A. baumanii were low for all antibiotics except for trimethoprim - sulfamethoxazole, S. pneumoniae and S. aureus were two primary pathogen of gram - positive bacterium. Analysis on antibiotics resistance of S. pneumoniae found that for penicillin , it was 71.1% ; for ciprofloxacin and vancomycin , it was 0%. 18.0% of S. aureus was MRSA, the sensitive antibiotics for it were ciprofloxacin, levofloxacin, and vancomycin. Conclusion Gram - negative bacterum is the primary pathogen causing lower respiratory infections of children, K. pneumoniae, E. coli, Ps. aeruginosa , A. baumanii , S. pneumoniae and S. aureus are their primary pathogen; the antibiotics resistance increases evidently. We must pay attention to antibiotics resistance of those bacterium, and some measures against them should be taken.